By Linda Finarelli
Staff Writer

The health care system in the United States is broken. That much was in agreement among those who spoke at a health care reform meeting hosted by state Rep. Josh Shapiro, D-153, Monday at Holy Redeemer Hospital.

“Clearly we’ve got to address access,” Holy Redeemer Health System President and CEO Mike Laign said. “Everyone should have access” to some measure of health care “so they are not living in fear.”

About 50 physicians, hospital administrators and other health care providers attended the forum aimed at soliciting input for a plan to meet President Obama’s goal of universal access to health care in the country. Shapiro was named last week as one of 32 state legislators nationwide to serve on the White House Team of State Legislators for Health Reform.

The team has been tasked with “helping the president shape the health care debate,” and subsequently to “cheerlead” for passage of a plan, Shapiro told the attendees, adding, “We are in the shaping phase.”

Access and cost are the two main factors, he said, with issues in Pennsylvania, such as not having enough primary care physicians and ob/gyns to treat people, shared by many states. Congressional committees are in the process of drafting legislation and “ideally a package will be ready to vote on in September or October,” Shapiro said.

“The current path — the status quo — in unsustainable,” he said. “The time is right; I need your help.”

Defensive medicine in the form of unnecessary tests, the high cost of medical school, the inflated cost of medical supplies and pharmaceuticals, patient expectations and philosophical issues regarding end of life care were among topics addressed by about 20 who offered comments at the meeting. Many also cautioned about rushing to formulate a plan.

The government “should be taking the time to do it right,” said Dick Jones, CEO of Abington Memorial Hospital.

Hospitals are working to reduce infection rates, unnecessary tests and hospital stays, but “something has to be done about tort reform,” Jones said. “We’re playing our part, but we can’t be totally nailed to the wall on cost,” he added, noting most hospitals make no margin on Medicare.

According to a report released in June by the Pennsylvania Health Care Cost Containment Council, hospitals’ operating margins dropped from 4.82 percent to 3.98 percent in fiscal year 2007-08, and almost a third of 169 that reported data had negative total margins.

Health care reform “is complicated” and “payment is not just the [only] issue,” said Dr. Arnie Cohen, chairman of obstetrics and gynecology at Einstein Hospital.

Patient expectations need to be changed, physicians need to be in charge of treatment and “tort reform belies everything we do in medicine,” Cohen said. “Everything we do every day is based on protecting ourselves.”

“Malpractice reform must be a key element of any reform. We need to resolve conflicts in a different fashion,” Montgomery County Medical Society President Mark Lopatin agreed.

“Patient expectation is huge … that to me is the core of the problem,” he said. Access is not impacted just by a lack of insurance, “there are backups due to unnecessary tests.” Defensive medicine costs about $100 billion a year, he said.

More than 80 percent of health care costs occur in the first and last years of people’s lives, said a doctor who identified himself as a nephrologoist who works at seven hospitals. There is a need to determine how to address “extra care for those who have no chance of survival.”

“When you have open health care, you have to put a brake somewhere — that’s on access,” he said. “Doctors need to be able to make decisions without fear of retribution.”

Government-sponsored health care would require a gatekeeper, agreed Dr. Marcelle Shapiro, a radiologist at Jeanes Hospital, who suggested questions raised would include whether every baby born at 20 weeks can be saved and whether patients who are failing should be put on dialysis.

Personal responsibility — five of the 10 leading causes of death are preventable, some due to smoking or being overweight — should be an element of reform and “we must have a frank conversation about end of life health care,” said Joanne Grossi, director of the state Department of Public Welfare Office of Women’s Services. People should either be given incentives or punished, in terms of paying for health care, she said.

The prevention side of health care could be a basic right, with separate funding for the “unanticipated side,” suggested Chuck Wagner, the chief medical officer for Holy Redeemer.

Addressing the lack of primary care physicians, Dr. Darilyn Moyer of Temple University Hospital said “the average medical student leaves with $165,000 indebtedness, so they are forced to go into a specialty. There is a need to provide a stream for primary care medicine.”

The United States has only half the number of primary care physicians needed, said Dr. Warren Matthews, chairman of family medicine at Abington Memorial. He suggested cutting funding to medical schools if they don’t have more go into primary care or provide tuition reimbursement.

Shapiro pointed out that he has twice sponsored legislation to forgive medical school loans for primary care doctors and ob/gyns who would agree to practice in Pennsylvania for 10 years. While approved in the House, the measure has stalled in the Senate.

“All of your comments will be summarized by me and my staff and will be submitted in a white paper” to the White House, Shapiro said. “It’s important for them to understand what’s going on on the ground.”